Provider Demographics
NPI:1922354950
Name:WYATT, AUGUSTA ELIZABETH ARLING (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTA
Middle Name:ELIZABETH ARLING
Last Name:WYATT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 S FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8711
Mailing Address - Country:US
Mailing Address - Phone:918-740-7934
Mailing Address - Fax:
Practice Address - Street 1:4901 W KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8511
Practice Address - Country:US
Practice Address - Phone:918-249-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist